Evaluation and treatment of infective endocarditis in children and adolescents with underlying CHD: a Paediatric Acute Care Cardiology Collaborative Clinical Practice Guideline

Julie B. Aldrich, The Heart Center, https://ror.org/003rfsp33Nationwide Children's Hospital, Columbus, OH, USA.
Nicolas Madsen, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Aimee K. Armstrong, The Heart Center, https://ror.org/003rfsp33Nationwide Children's Hospital, Columbus, OH, USA.
Julianne Burns, Division of Infectious Diseases, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.
Missy Collins, Independent Scholar, Lexington, KY, USA.
Caitlyn Coward, Children's Healthcare of Atlanta Heart Center-Cardiac Intensive Care Unit, Atlanta, GA, USA.
Samuel Z. Davila, Department of Pediatrics, Divisions of Critical Care Medicine and Infectious Diseases, University of Texas-Southwestern, Dallas, TX, USA.
Vivian Dimas, Medical City Children's Hospital, Dallas, TX, USA.
Alexandra Erdmann, Division of Cardiology, Department of Pediatrics, American Family Children's Hospital, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
Yasaman Fatemi, Division of Infectious Diseases, Seattle Children's Hospital, Seattle, WA, USA.
Bryan H. Goldstein, Heart Institute, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
Ashraf S. Harahsheh, Children's National Hospital, Division of Pediatric Cardiology, Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Sairah Khan, Children's National Hospital, Division of Pediatric Cardiology, Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Alaina Kipps, Division of Cardiology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.
Michael H. Kwon, Boston Children's Hospital, Department of Cardiac Surgery, Harvard Medical School, Boston, MA, USA.
Elizabeth Lyman, Grant Morrow III MD Medical Library, Nationwide Children's Hospital, Columbus, OH, USA.
Holly Maples, Department of Pharmacy Practice, University of Arkansas for Medical Sciences College of Pharmacy, Little Rock, AR, USA.
Sandra L. Merklinger, Labatt Family Heart Center, The Hospital for Sick Children, Toronto, ON, CA.
Danielle Sganga, Boston Children's Hospital, Department of Cardiology, Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
Christopher Stang, Department of Patient Services, Division of Pharmacy, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Ram K. Subramanyan, Criss Heart Center, Children's Nebraska, Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA.
Sumeet Vaikunth, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
Dana Gal, Children's Hospital of Los Angeles, Division of Pediatric Cardiology, Department of Pediatrics, Keck School of Medicine, Los Angeles, CA, USA.

Document Type

Journal Article

Publication Date

12-30-2025

Journal

Cardiology in the young

DOI

10.1017/S1047951125110561

Keywords

CHD; Paediatrics; infective endocarditis; transcatheter pulmonary valve replacement

Abstract

BACKGROUND: Infective endocarditis is a leading cause of morbidity and mortality in children and adolescents with underlying CHD. Appropriate diagnostic workup and management in the inpatient setting can be challenging in this patient population due to the spectrum of disease complexity and the dynamic nature of the field. Therefore, the Paediatric Acute Care Cardiology Collaborative has undertaken the creation of this clinical practice guideline. METHODS: A panel of paediatric cardiologists, infectious disease specialists, intensivists, advanced practice practitioners, pharmacists, cardiothoracic surgeons, and a dentist was convened. The literature was systematically reviewed for relevant articles on the management of infective endocarditis in patients with CHD. Using the modified Delphi technique, recommendations were generated and put through iterative Delphi rounds to achieve consensus for inclusion. RESULTS: Based on 127 articles that met the inclusion criteria, 82 recommendations were generated, 50 of which achieved consensus for inclusion and are included in this guideline. They address risk factors specific to CHD lesion type and prior interventions including implanted material, diagnostic considerations, management strategies, and recommendations on counselling other healthcare providers, patients, and families. Of the 50 consensus recommendations, 36 are strong recommendations, though 20 have low or very low quality of evidence. CONCLUSIONS: A central theme in this guideline is that an individual's specific CHD lesion and prior interventions must be carefully considered for risk stratification, diagnostic approach, and management. While most are strong recommendations, many are supported by low quality of evidence, emphasising the need for further research in this subject.

Department

Pediatrics

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